Richard J. Baron, MD, FACP President and CEO Healthier Babies, Healthier Futures, Inc
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Healthier Babies: A Regional Collaborative to Improve Birth Outcomes for Pregnant Women on Medicaid Richard J. Baron, MD, FACP President and CEO Healthier Babies, Healthier Futures, Inc National Disease Management Summit Baltimore, MD May 13, 2003
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Healthier Babies: A Regional Collaborative to Improve Birth Outcomes for Pregnant Women on Medicaid. Richard J. Baron, MD, FACP President and CEO Healthier Babies, Healthier Futures, Inc National Disease Management Summit Baltimore, MD May 13, 2003. Maternity in Medicaid. High prevalence - PowerPoint PPT Presentation
Transcript of Richard J. Baron, MD, FACP President and CEO Healthier Babies, Healthier Futures, Inc
Healthier Babies: A Regional Collaborative to Improve Birth Outcomes for Pregnant Women on Medicaid
Richard J. Baron, MD, FACPPresident and CEO
Healthier Babies, Healthier Futures, Inc
National Disease Management SummitBaltimore, MDMay 13, 2003
Maternity in Medicaid
High prevalence• Medicaid population demographics• Pregnancy as Medicaid qualifying
event Big percentage of overall hospital
use in a Medicaid Plan (NCQA data)• Total Discharges/1000 MM=8.35• Maternity Discharges/1000 MM=3.55• Meaning Maternity=42.5% ALL Hosp
Clinical and Financial Impact of LBW
LBW infants 40 times more likely to die in first 4 weeks of life
Average 1st year of life costs for LBW infants: $93,800
Savings for LBW over VLBW infant: $59,700
Estimated savings per dollar invested in LBW prevention: $3
Source: NCQA Web Site
Medicaid Patients do worse
NY State Pooled Managed Care Data•Total population: 6,977,275•25 Commercial Plans, 21 Medicaid
Plans
Risk-Adjusted Low Birth Weight
4.3 4.3 4.6
9.28.3
9
01
23
45
67
89
10
Commercial Medicaid
199719981999
Population
Rat
e
Commercial v.s. Medicaid
Medicaid Patients do worse
Healthy People 2000 LBW Goal: 5%
Healthier Babies Medicaid LBW: 11.3%
What are the challenges to improving birth outcomes?
Some intrinsic to Medicaid• Population turnover• “Social issues”: housing, poverty,
education• Cultural barriers
Some “clinical”• Absence of clear knowledge base on
“what works”• Significant co-morbidities (Substance
Use, HIV, Mental Health. . .)
History and BackgroundHBHF
• RWJF RFP: “Mending the Safety Net”• HealthChoices: Pennsylvania’s
Mandatory Medicaid Managed Care Program– Philadelphia and 4 surrounding counties
• 4-6 Potential Contractors• 15,000 deliveries per year
Broad, simple concept:
• Agree on one standard prenatal clinical data collection tool for MMCOs– Replace a heterogeneous,
overlapping approach• Build a centralized database to receive
data• Link with DOH Birth Certificate Database• Produce state-mandated HEDIS and
other reports
Problems identified at RWJF/CHCS site visit:
• Long term funding• Confidentiality
– Administrative/legal– Control/appropriate use
• Ownership
UPEF Development
• Clinician in charge• Commitment to a one page form• Commitment to obtain only data that
would or should be available to a clinician at each visit
• Commitment to capture relevant clinical and “social” risks
• Initial input broadly participatory, final execution very narrow
• Field tested
Barriers
• Competitiveness• Resource constraints under
HealthChoices• Confidentiality• Marketplace events• Provider and Advocate concerns• “Null hypothesis” for prenatal
intervention
Governance
• New non-profit corporation: Healthier Babies, Inc
• Solved both ownership and control issues• Three classes of Directors
– Appointed Directors– Health Department Directors– At Large Directors
• Has itself created opportunity for collaborative action
Critical Success Factors
• Defined universe of MMCOs• Defined universe of providers• Clearly (sort of) defined clinical
data set• Leadership
Results
• We exist, Board meets every other month
• We have Bylaws, contracts, money• Over 90% of prenatal encounters are
reported– 5 counties, 225 sites, 800 providers
• Database actually works– Case management– Reporting
Healthier Babies - Monthly Form Volume - 2000Total Encounter Forms Entered From 1/1/00 - 12/31/00: 104,694
Average Number of Forms Entered Per Month: 8725
0
2000
4000
6000
8000
10000
12000
J F M A M J J A S O N D
Month
Intake (n = 16,512) Follow Up (n = 84,489) Post Partum (n = 3,693)
Healthier Babies - Monthly Form Volume - 1999Total Encounter Forms Entered From 1/1/99 - 12/31/99: 92,311
Average Number of Forms Entered Per Month: 7693
0
2000
4000
6000
8000
10000
12000
J F M A M J J A S O N D
Month
Intake (n = 15,256) Follow Up (n = 73,589) Post Partum (n = 3,466)
HEALTHIER BABIES: UPEF ENTRIES: 1999-2001
Healthier Babies - Monthly Form Volume - 2001Total Encounter Forms Entered From 1/1/01 - 12/31/01: 83,631
Average Number of Forms Entered Per Month: 6969
0
2000
4000
6000
8000
10000
12000
J F M A M J J A S O N D
Month
Intake (n = 13,518) Follow Up (n = 66,559) Post Partum (n = 3,554)
Company A HEDIS Improvement
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
HEDIS Measure
Without HB
With HB
Company B HEDIS Improvement
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
HEDIS Measure
Without HB
With HB
Figure 1. Weight Of Selected Risk FactorsFigure 1. Weight Of Selected Risk Factors Based On Their Strength Of Predicting Based On Their Strength Of Predicting
Poor Birth OutcomePoor Birth Outcome (2000/2001 Births)(2000/2001 Births)
Risk Factor PopulationPrevalence
Weight
Prior Preterm Birth 9.29% 13.9
Prior Low Birth Weight 9.98% 12.9
Cocaine/Heroin/Amphetamine Use 1.86% 12.4
Medical History: Diabetes 1.11% 10.2
Medical History: Hypertension 1.66% 10.0
Prior Pregnancy Complication 13.68% 9.6
Prior Infant Death 2.66% 9.0
Disabled Eligibility Status 4.0% 8.7
Less than 3 Recorded Visits 19.75% 6.7
Alcohol Use 3.94% 6.1
Prior Pregnancy Hypertension 3.29% 6.0
Marijuana Use 4.57% 4.8
Age Greater than 34 5.97% 4.7
Ever Homeless 5.87% 4.0
Tobacco Use 15.03% 3.7
Mental Illness 5.37% 2.7
66.4% 68.5%
23.6% 21.3%
10.0% 10.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
N=9838
Health Choices
N=6624
Top 24 Providers
0 to 9.49 = Low 9.5 to 25.49 = Medium 25.5 to 120 = High
Figure 3. Weighted Risk Score
66.4%
78.5%
54.8%
23.6%
16.0%
32.7%
10.0%5.5%
12.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
N=9838Health Choices
Population
N=163Provider P
N=104Provider S
25.5 and higher = High
9-5 - 25.49 = Medium
0-9.49 = Low
Figure 4: Weighted Risk Score for 2 Selected Individual Providers Compared to Health Choices Population
Figure 5. Mean Weighted Risk Scale: Top 24 Providers (Overall Mean = 9.49)
Provider ID
11
31
11
27
111
5
111
4
111
2
11
00
10
88
10
84
10
82
10
45
10
38
10
19
10
11
10
08
10
07
99
1
96
9
94
2
92
9
90
2
89
7
84
9
84
6
81
4Me
an
We
igh
ted
Ris
k S
ca
le: 1
6 Ite
ms
14
12
10
8
6
4
Figure 6a. Sample Provider Outcome Report: Low Medium, and High Risk Group Poor Birth Outcomes Compared To The Population
12.4%
19.8%
30.6%
12.5%
23.1%
55.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Low Risk Medium Risk High Risk
% P
oo
r B
irth
Ou
tco
me
Health Choices Population Provider P
Health Choices Population
Figure 6b. Sample Provider Outcome Report: Low, Medium, and High Risk Group Poor Birth Outcomes Compared to The Health Choices Population
17.5%
29.4%
23.1%
12.4%
19.8%
30.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Low Risk Medium Risk High Risk
% P
oo
r B
irth
Ou
tco
me
Provider S
Figure 6. Provider Variation in Birth Outcome By Figure 6. Provider Variation in Birth Outcome By Risk GroupRisk Group
(Largest 30 Providers)(Largest 30 Providers)
2 0 0 1 : P r o v i d e r V a r i a t i o n i n B i r t h O u t c o m e
Perce
nt Po
or Bir
th Ou
tcome
70
60
50
40
30
20
10
0
-10
L o w R i s k M e d i u m R i s k H i g h R i s k
M e a n = 3 2 . 6
M e a n = 1 1 . 9
2 0 0 0 : P r o v i d e r V a r ia t i o n i n B i r t h O u t c o m e
Perc
ent P
oor B
irth
Outc
ome
70
60
50
40
30
20
10
0
-10
M e a n = 1 2 . 6
L o w R i s k M e d i u m R i s k
M e a n = 1 9 . 8
M e a n = 2 9 . 8
M e a n = 1 9 . 9
High Risk
Mean = 19.9
Low Birth- Weight in Healthier Babies Population
12.2%
11.6%
11.8%
12.3%
13.2%
12.0%
11.3%
11.1%
12.4%
0.0% 5.0% 10.0% 15.0% 20.0%
1999
2000
2001
% Low Birth-Weight
Total M A population M A Births w/o UPEF M A Births w/ UPEF
Healthier Babies,Healthier Futures
N=13,467
N=4,165
N=9,302
N=13,932
N=4,096
N=9,836
N=13,618
N=5,344
N=8,274
Low Birth- Weight Percentage in Healthier Babies Population
5.0%
5.0%
5.0%
11.8%
11.1%
13.2%
11.6%
11.3%
12.0%
12.4%
12.3%
12.2%
0.0% 5.0% 10.0% 15.0% 20.0%
Total M A population
M A Births w/ UPEF
M A Births w/o UPEF
% Low Birth-Weight
Healthy People 2010 Goal Healthier Babies Population 2001Healthier Babies Population 2000 Healthier Babies Population 1999
Healthier Babies,Healthier Futures
N=5,344
N=4,096
N=4,165
N=8,274
N=9,836
N=9,302
N=13,618
N=13,932
N=13,467
Low Birth Weight Percentage in Healthier Babies Population
(MA births with at least one UPEF)
5.0%
11.1%
11.3%
12.0%
0.0% 5.0% 10.0% 15.0% 20.0%
Healthy People2010 Goal
Healthier BabiesPopulation 2001
Healthier BabiesPopulation 2000
Healthier BabiesPopulation 1999
% Low Birth Weight
Healthier Babies,Healthier Futures
Key ConstituentsHealthier Babies, Healthier Futures, Inc.
• AmeriChoice of Pennsylvania• Health Partners of Philadelphia• Keystone-Mercy Health Plan• Community Behavioral Health System• Philadelphia Health Management Corp• Philadelphia Department of Public
Health• Department of Public Welfare,
Commonwealth of Pennsylvania
